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ADHD Lectures Online
View 10 hours of parent presentations and
25+ hours of professional presentations on
ADHD by Dr. Barkley at this website:
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Presenter Disclosure – Prior 12 MonthsSpeaker (Honoraria):
Cove School, Northbrook, IL
Learning Disability Association Annual Conference, Lebanon and Kuwait
ADHD Workshop, Brooklyn College, NY
Vera French Mental Health Center, Davenport, Iowa
Georgetown Pediatrics Annual Conference, Pawleys Island, SC
Eisenhower Army Medical Center, Fort Gordon, August, GA
Door County Institute, Medical College of Wisconsin, Milwaukee
Stixrud Group, Mental Health Services, Rockville, MD
Philippines ADHD Conference
Royalties:
Guilford Publications (books, videos, newsletter);
J & K Seminars (workshop DVDs);
Premier Educational Seminars Inc. (PESI) (web courses and books);
ContinuingEdCourses.net (web courses),
PsychContinuingEd.com (web courses)
Industry Speaker/Consultant:
Eli Lilly (China) - Speaker
Ironshore Pharmaceutical & Development, Inc. - Consultant
School Management of ADHD
Russell A. Barkley, Ph.D.
Clinical Professor of Psychiatry
Medical University of South Carolina
Charleston, SC
©Copyright by Russell A. Barkley, Ph.D., 2017
Sources:
Barkley, R. A. (2015) Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford.
Barkley, R. A. (2016). Managing ADHD in School: The Best Evidence-Based Methods for Teachers. Eau Claire, WI: PESI
Email: [email protected]
Website: russellbarkley.org
Understanding the SymptomsThe two dimensions of
neuropsychological development/functioning are:
1. Hyperactivity-Impulsivity (Executive Inhibition)Deficient motor inhibition (restless, hyperactive)
Impaired verbal inhibition (excessing talking, interrupting)
Impulsive cognition (difficulty suppressing task irrelevant thoughts, rapid decision making;
Impulsive motivation (prefer immediate gratification, greater discounting of delayed consequences)
Emotion dysregulation (impulsive affect; poor “top down” emotional self-regulation)
Restlessness decreases with age, becoming more internal, subjective by adulthood
More on ADHD Symptoms2. Inattention: But 6 types of attention exist –
not all are impaired in ADHD. What is?
Executive Attention (& Functioning)
Poor persistence toward goals, tasks, and the future (can’t sustain attention/action over time)
Distractible (impaired resistance to responding to goal-irrelevant external and internal events)
Deficient task re-engagement following disruptions (skips across uncompleted tasks)
Impaired working memory (forgetful in daily activities, cannot remember what is to be done)
Diminished self-monitoring
Touchstone Principles for
ManagementTeachers are Shepherds, Not
EngineersAdjust your attitude toward ADHD – It’s a Neuro-
Developmental Disability
Intervene at the “Point of Performance”
Externalize Important Information
Externalize Time, Reduce Delays
Externalize Motivation (Think win/win)
Use Immediate Feedback
Increase Frequency of Consequences
More Touchstone Principles
Externalize Problem-Solving –
make it manual
Use Rewards Before Punishment
Use More Salient & Artificial Rewards
Change Rewards Periodically
Increase Accountability to Others
Anticipate Problem Settings
Make A Plan
More Touchstone Principles
Touch More, Talk Less
Act, Don’t Yak
Keep Your Sense of Humor
Keep A Sense of Priorities
Practice Forgiveness
(Child, Self, Parents)
Supplement with medications as needed
Basic Considerations
Have a school ADHD liaison for parent-teacher coordinated care
Don’t retain in grade!
Harmful to children – don’t delay treatment
Use Sept to establish behavioral control
Use traditional desk arrangement
Seat child close to teaching area
Use this opportunity to provide more frequent feedback to child
Touch child on shoulder while teaching if child seems restless or inattentive
Ideas for Desk WorkTarget productivity first, accuracy later
Decrease total workload, or
Give smaller quotas of work at a time
Allow child to choose the initial quota
Use participatory teaching methodsChild actively involved in teaching the lesson
Practice skills drills on computers
Allow some restlessness at work area
Consider having child sit on balance ball
Give frequent exercise breaks
About That HomeworkReduce/eliminate homework – grades 1-6
Overall correlation with achievement is just .15-.25 (just 2-6% of variance in achievement) across all grades and weaker in elementary grades*
For high school, best amount was 1.5-2.5 hrs/night; more hours had no further benefits*
Don’t send home unfinished class work for parents to do - home is not the “point of performance” for class work
Give weekly homework assignments in advance for better parent preparation
During homework: Some noise or music benefits work performance (but deteriorates it in normal kids)**
*Cooper, Robinson, & Patall (2006). Review of Educational Research, 76(1), 1-62.
**Soderlund et al. (2007). Journal of Child Psychology and Psychiatry, 48, 840-847.
Instructional Tips:Be more animated and theatrical
Personalize praise, reprimands, or instructions
Make eye contact, touch child on shoulder or arm, have child repeat back any instructions
Consider the “Turtle Technique” for
early elementary grades
Try laminated work slates for writing
down and displaying answer, not
hands in air and fastest responder wins
Schedule most difficult subjects in AM
Intersperse low with high appeal activities
More Classroom Suggestions:
Require continuous note-taking during lectures & while reading
Use the SQ4R system for improving reading comprehension
Survey, questions, read, recite, write, review
Get color-coded binders & other organizing systems for classwork
Give after-school help-sessions, tutoring, books on tape, videos, etc.
Train keyboarding in early grades
Establish “behavioral contracts”
Peer Tutoring Create & distribute scripts (work sheets)
Teach any new concepts and skills to class
Provide initial instructions for work, then
Break class into dyads
Have one student tutor & quiz the other
Circulate, supervise, and coach dyads
Alternate tutor/student roles in dyad
Re-organize into new dyads weekly
Graph & post quiz results
Allow peer tutoring for homework – find child
a “study-buddy” in their neighborhood
Components of Behavioral ContractsSets forth academic work and behavioral
goals explicitly and clearlyI agree to complete all of my written math and language arts
work with at least 80% accuracy
I will remain quiet, follow directions, and listen
Specifies rewards to be earned explicitly15 extra minutes of playtime at end of school day
Access to special “reserved” toys or play activities
Use class computer for play or work for 15 extra minutes
Receive 10 points for every task completed accurately
Help my teacher by completing some errands or in-class jobs
If I have a successful week, I will earn a special activity with my
parents
Specifies punishment explicitlyLoss of 10 points or tokens for each task not completed
5 Sheets of “do a task” in time out
Increasing IncentivesIncrease praise, approval, appreciation
Be a 1-minute manager
Use a token or point system to organize consequences – to increase available rewards:
Get parents to send in old games/toys
Get a video game donated to the class
Allow access to rewards often each day
Keep reward - punishment ratio 2:1+Remember – its an incentive program
More on IncentivesTry team-based (group) rewards
4-5 students work as a team on assignments and to earn rewards
Be careful to change team composition every day or two and rotate ADHD child frequently to different teams
Try a tone-tape with self-rewardsVariable interval schedule of tones played during desk work periods
When tone sounds, child self-rewards points on record sheet
Teachers monitor for cheating
Increase intervals between tones each week
Eliminate after 3-4 weeks – replace with standard point system
Attention Training SystemGordon Systems, gsi.com
The Motivaider & Invisible ClockHabitchange.com addwarehouse.com
Using School-Home Reports
with Home-Based ConsequencesDaily goals stated in positive manner
Specifies behavioral and academic goals
Targets a small number of goals
Teacher provides quantitative feedback
Feedback provided at end of each class
Regular communication with parents (daily)
Consequences at home are tied to school
behavior and performance (short & long-term)
Solicit parental cooperation before starting
Student input into goals is solicited for older
children and teens
Review weekly for modifications
A Daily Behavior CardEach teacher rates each behavior at end of each class; 1=Excellent (+25), 2=Good
(+15), 3=Fair (+5), 4=Poor (-15), 5=Terrible (-25)
Subjects 1 2 3 4 5 6 7ClassParticipation
Performs assignedclasswork
Follows class rules
Gets along wellwith others
Completes home-work assignments
Teacher’sInitials
School-Home Notes
• Name_______________________ Date________
• Subject____________ Teacher_______________
• Was prepared for class Yes No NA
• Used time well Yes No NA
• Handed in homework Yes No NA
• Followed class rules Yes No NA
• Homework or Test Grade (circle one): ____________
• Teacher’s Initials_______
• Homework Assignment:
• Comments:
From Kelly, R. (1990). School-home notes: Promoting children’s classroom success. New York: Guilford Press
Problem Transitions? Make a PlanBefore entering a new situation, STOP! (in school
this might be the next class, recess, going to lunch
room)(at home, this would be any transition to a
new task or situation (homework, bedtime, chores,
shopping trip, dining out, church, visiting others,
etc.)
Review 2-3 rules child needs to obey
Child repeats them back
Establish an incentive or reward
Establish the punishment to be used
Be sure child has something active to do
Enter the new situation, follow your plan
Reward throughout the activity
End by evaluating success with the child
Externalizing Rules and TimePost rules on posters at front of class for each work period,
Use 3-sided stop sign for rules for young kids. Show the appropriate side for each activity: red side = lecture rules; yellow side = desk work rules; greenside = play rules
Laminated color-coded card sets placed on desk with each card listing the basic rules or steps to be followed for each subject or class activity in school or each recurring task (i.e. homework) or chore (clean up).
Child reviews the posted rules or steps and then verbally restates them at the start of each activity. Child can also place a checkmark next to each step as it is done.
Use timers, watches, large clocks, etc. if the task has a time limit.
Watch MinderWatchMinder.com
Wristlistswristlists.com
Large 12” Timeraddwarehouse.com
The Large Time Timer is designed to be
wall hung for classroom and group
activities. It’s large size (12 inches square)
and bold dial numerals make this timer
easier to read for visually impaired users,
as well. How it works:
To set the Large Time Timer, move the red
disc counterclockwise to the desired time
interval. The disc diminishes as time
elapses until no red is visible on the timer
face. The disc may be moved clockwise or
counterclockwise without harming the
mechanism, however gentle handling will
prolong the life of the timer.
Disciplinary TacticsIncentives for appropriate behavior must be present for punishment (loss of reward access) to be effective
But all-reward programs do not last long with ADHD children unless accompanied with punishment tactics
Swift justice is the key to discipline
Mild, private, direct reprimands work –personalize it
Response Cost (loss of tokens)
“Do A Task” (a variation on time out)Desk at back of class with worksheets
Child told what they did wrong and given a number
Child does that number of worksheets while timed out
More Punishment TacticsThreaten to use your smart phone to record outbursts or tantrums that will be emailed to parent
Moral essays – “Why I will not hit others”
Establish a “chill out” location – for recovering self-control
Formal time out in class roomHallway time outs don’t work
In-school suspension
Keys to Effective Time Outs
Implemented only when there is a
reinforcing environment to be removed from
Used when function of child’s behavior is
attention-getting
Employed swiftly upon rule infraction (10
sec.)
Uses smallest amount of time out1-min./year of age
Location is to be visible to teacher
Terminate when:Time out interval has been served
Child is quiet for brief period of time
Child agrees to obey rule that was broken
“Challenging Horizons”
After-school program for teens2 days per week for 2 hours each at school
Uses groups and 1:1 delivery Therapists are paraprofessionals – M.A. level
Program includes:Academic tutoring & homework assistance
Organizational, study and self-monitoring skills
Social skills training
Recreational skills and deportment
Encouraged generalization of social skills
Group level token system for behavior control
Consult with teachers on behavior management methods
Parent education and training
3 sessions/2 hrs. each
Challenging HorizonsTreatment precludes worsening of adjustment
over time evident in untreated students
Treatment reduces & forestalls failure events
Reduces ADHD symptoms at school
Improves academic performance
Improves internalizing symptoms
But not delinquent or conduct disorder behavior
Boosts medication effects
High parent/teacher acceptability and satisfaction
Less costly than clinic-based services
Greater teen participation in treatmentMolina, B. S. et al. (2008). Journal of Attention Disorders, 12(3), 207-217.
Schultz, B. et al. (2009). School Psychology Review, 38(1), 14-27.
Other Tips for TeensAs needed, use ADHD medications
Find a “Coach” or “Mentor” (Just 15 min.)
The Coaches’ office is the student’s “locker”
Schedule in three 5-minute checkups across each day
Use behavior report card to monitor teen across classes
Use daily assignment sheets requiring teacher initials
Cross temporal accountability is the key to success
Keep extra set of books at home
Tape record important lectures – check out the Smart Pen that digitally records lectures or other conversations at livescribe.com
The SmartPenLivescribe.com
A computer in a pen that
helps you never miss a
word™. Pulse™ records
everything you hear, say
and write, and links your
audio recordings to your
notes. Find the most
important information from
your meetings or lectures
just by tapping on what you
wrote.
2GB of memory can hold
over 200 hours of audio.
Actual recording time
varies by audio quality
setting.
More Tips for TeensGet a Week-at-a Glance calendar, a journal, or other organizing notebook
Extra time on timed tests ???No evidence it preferentially benefits disabled students – at most 20-30 minutes maximum
Better to have distraction free test setting and breaks after short testing periods (time off the clock)
Get written syllabus as handouts
Require continuous note-taking to pay attention to lectures or during reading assignments
Still More Tips for Teens
Use SQ4R for reading comprehension
Find “fall-back” classmates (swap phone, e-mail, & fax numbers) for lost or missing assignment sheets
Require teen to attend after-school help-sessions
“Bucks for Bs” system – parents pay money for grades on assignments
Schedule parent-teacher-teen review meetings every 6 weeks (not at 9 week grading period)
ConclusionsThe school is the setting most impaired for children
and teens with ADHD
ADHD symptoms can be effectively managed in
school using numerous behavior modification
methods and classroom accommodations
These can result in significant improvements in the
child’s academic performance, behavior, and peer
interactions
The keys to success include teacher attitude toward
and knowledge of ADHD and the willingness to
implement and sustain these interventions
In some cases, however, medications may need to
be combined with school management methods to
achieve maximum benefits
